A Case of Schwannoma Located in the External Auditory Canal / 대한이비인후과학회지

Schwannoma is slowly-growing, benign tumor that originates from the schwann cell and is rarely found in the external auditory canal (EAC). In this article, we describe a 30-year-old female patient with 12x7x4 mm EAC schwannoma located between the helical crura and tragus of the left ear. The schwannoma was easily removed by local excision. We discuss the differential diagnosis, clinical and histologic features, and treatment of EAC schwannoma.

Curcumin Enhances Docetaxel-Induced Apoptosis of 8505C Anaplastic Thyroid Carcinoma Cells

BACKGROUND: Anaplastic thyroid cancer (ATC) is one of the most aggressive malignancies in humans, and its progression is poorly controlled by existing therapeutic methods. Curcumin has been shown to suppress inflammation and angiogenesis. In this study, we evaluated whether curcumin could augment docetaxel-induced apoptosis of ATC cells. We also analyzed changes in nuclear factor kappaB (NF-kappaB) and cyclooxygenase-2 (COX-2) expression levels to delineate possible mechanisms of their combined action. METHODS: ATC cells were cultured and treated with curcumin and docetaxel alone or in combination. The effects on cell viability were determined by MTS assay. Apoptosis was assessed by annexin V staining and confirmed by flow cytometric analysis. Caspase, COX-2, NF-kappaB levels were assayed by Western blotting. RESULTS: Curcumin combined with docetaxel led to lower cell viability than treatment with docetaxel or curcumin alone. Annexin V staining followed by flow cytometric analysis demonstrated that curcumin treatment enhanced the docetaxel-induced apoptosis of ATC cells. Additionally, curcumin inhibited docetaxel-induced p65 activation and COX-2 expression. CONCLUSION: We conclude that curcumin may enhance docetaxel's antitumor activity in ATC cells by interfering with NF-kappaB and COX-2. Our results suggest that curcumin may emerge as an attractive therapeutic candidate to enhance the antitumor activity of taxanes in ATC treatment.

Perineural Involvement in Benign Mixed Tumor

No abstract available.

Transient right hemidiaphragmatic paralysis following subclavian venous catheterization: possible implications of anatomical variation of the phrenic nerve: a case report / 대한마취과학회지

Phrenic nerve paralysis is an unusual complication associated with central venous catheterization. Various mechanisms have been proposed. We present a case of transient right hemidiaphragmatic paralysis after subclavian venous catheterization. We hypothesize that anatomical variation of the phrenic nerve was responsible for this complication.

Two Cases of Intracranial Complications Associated with Chronic Silent Otitis Media in Immune-Competent Adults / 대한이비인후과학회지

Chronic otitis media is defined as a condition associated with a perforation of the tympanic membrane with a history or existence of otorrhea. Chronic silent otitis media refers to chronic pathologic condition behind an intact tympanic membrane, which may be clinically undetected or undetectable. Because this chronic pathology is undetected, there is a lack of clinical treatment, which increases the risk of complications and sequelae. Otogenic intracranial complications in intact tympanic membrane are usually reported in pediatric patients with acute otitis media and are rare in immune-competent adult patients. We report two cases of immune-competent patients who suffered from intracranial complications of chronic silent otitis media, one leading to a lateral sinus thrombophlebitis and the other leading to meningitis.

Cervical Esophageal Hemangioma Combined with Thyroid Cancer

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.

Cervical Esophageal Hemangioma Combined with Thyroid Cancer

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.

Treatment Outcomes of Squamous Cell Carcinoma of the Buccal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of the buccal mucosa (BMSCC) has been known to have poor prognosis characterized by a high locoregional failure rate. The purpose of this study is to assess the current treatment outcome and to estimate the prognostic factors in patients with BMSCC. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 20 patients who were diagnosed and treated for BMSCC between August 1996 and May 2008. Potential prognostic factors including age, gender, stage, histologic grade, treatment modality were evaluated. RESULTS: The 5-year overall survival and failure-free survival rate were 47% and 42%, respectively. The 3-year overall survival rate in the early staged carcinoma (stage I and II) was 76%, and in the advanced staged carcinoma (stage III and IV), 38% (p=0.022). Patients who had surgery as initial treatment or well differentiated cancer achieved better overall survival rates (p=0.003, p=0.018). Forty-five percent of patients had treatment failure during follow-up. The univariate analysis showed that clinical stages and histologic grades are the two most important prognostic factors responsible for treatment failure. CONCLUSION: The 5-year survival rate of BMSCC was 47%. The strong influence of disease stage on prognosis emphasizes the importance of early diagnosis of BMSCC and aggressive treatment for patients with poorly/moderated differentiated cancer.

Is Routine Central Neck Dissection Necessary for the Treatment of Papillary Thyroid Microcarcinoma?

OBJECTIVES: It remains unclear as to whether routine central neck dissection (CND) is necessary when performing surgery to treat patients with papillary thyroid microcarcinoma (PTMC). To determine the necessity for routine CND in PTMC patients, we reviewed the clinicopathologic and laboratory data of the patients of PTMC. METHODS: Between September 2001 and July 2005, 101 patients with PTMC and clinical N0 disease were retrospectively reviewed. The study cohort was devided into groups: the total thyroidectomy plus CND group (the CND group, N=48) and the total thyroidectomy without CND group (the no CND group, N=53). The serum stimulated thyroglobulin (Tg) levels were measured after surgery and prior to radioactive iodine ablation therapy (RAI) and at 6-12 months after RAI. Pathology, the Tg levels and recurrence data were compared between the 2 groups. RESULTS: Central nodal metastases were found in 18 of the 48 CND patients (37.5%). The incidence of Tg levels >5 ng/mL at RAI was higher in the no CND patients and in the 18 node-positive CND patients compared with the 30 node-negative CND patients (22-24% vs. 3%, respectively, P=0.020-0.058). The difference when performing a similar comparison using a >2 ng/mL Tg threshold level showed no significance (10-11% vs. 4%, respectively, P>0.1). Two of the no CND patients and one node-positive CND patient had recurrences in the thyroid bed or lateral neck during a mean follow-up of 24 months. CONCLUSION: The data showed that occult metastasis to the central neck is common in PTMC patients. A CND provides pathologic information about the nodal metastases, and it potentially provides guidance for planning the postoperative RAI. However, the long-term benefit of CND on recurrence and survival remains somewhat questionable.

Inhibitory effects of Enterococcus faecium isolated from Korean infants on oral pathogens / 대한치주과학회지

PURPOSE: The probiotic effects of lactic acid bacteria have widely been researched in diverse human pathogens, but only a few effects are reported against oral pathogens. The antimicrobial effects of the Enterococcus faecium 7413 isolated from Korean infants on the 9 pathogen including 6 oral streptococci were investigated the clinical use of the antimicrobial peptide for oral microflora control. MATERIALS AND METHODS: E. faecium 7413 was identified by morphological, biochemical tests and 16S rDNA sequence analysis. Inhibitory effects of culture supernatants were determined for their ability to grow on agar plate containing pathogenic bacteria. RESULT: The culture supernatant of Enterococcus faecium 7413 showed inhibitory effects on oral pathogens, namely Streptococcus pyogenes KCTC 3556, S. pneumoniae KCTC 5080, S. mutans ATCC 25175, S. anginosus ATCC 33397, S. constellatus KCTC 3268, S. intermedius ATCC 27823 and Shigella flexneri KCTC 2008. Whereas it did not affect the multiplication of E. coli strains, KCTC 1041 and ATCC 43894. CONCLUSION: The data obtained in this study could be useful for future development of effective probiotics allowing prevention for oral pathogens.

Clinical Usefulness of Vestibular Evoked Myogenic Potential in Unilateral Meniere's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Because the saccule, next to the cochlea, is the second most frequent site of hydrops formation, we evaluated whether vestibular evoked myogenic potential (VEMP) responses can reflect the diagnosis and the stage of Meniere's disease. SUBJECTS AND METHOD: Retrospectively, we analyzed the results of VEMP in 40 patients (11 men and 29 women) with unilateral definite Meniere's disease. All subjects underwent VEMP testing using ipsilateral 500 Hz-tone burst sound with 90 dBnHL (rise/fall time=2 msec, plateau time=3 msec). RESULTS: VEMP was present in 92.5% of Meniere's affected ear (37/40). The latency of p13 of affected ears in patients with Meniere's disease was significantly prolonged than that of normal ears in the control group (p=0.05). However, no relationship was found in latencies of p13, n23, and interpeak latency among groups classified by the stage of Meniere's disease. In the patients with Meniere's disease, the mean interaural amplitude difference (IAD) ratio was 23.9+/-16.9%. The IAD ratio of patients with Meniere's disease was larger than that of the control group, but it is statistically insignificant (p=0.133). CONCLUSION: Prolonged p13 latency of VEMP was a pathognomic finding for Meniere's disease in this study.

Ovarian follicular and peritoneal fluid prostaglandin E2 and F2a levels according to the clinical symptoms in the women with endometriosis / 대한산부인과학회지

OBJECTIVE: The purpose of the present study was to determine whether a relationship exists between the clinical symptoms (dysmenorrhea and infertility) and prostaglandin (PG) concentrations in follicular and peritoneal fluid in the women with endometriosis during the late follicular phase of the menstrual cycle. METHODS: Thirty patients with pelvic endometriosis diagnosed by pelvic surgery were enrolled. Eight patients were suffering from severe dysmenorrhea and 11 had history of primary or secondary infertility among them. Endometriosis patients were grouped by the presence of each symptom and compared with 33 control patients without endometriosis. Peritoneal fluid was collected in the beginning of peritoneal opening and dominant follicular fluid was aspirated by syringe needle at the time of operation. Then PGE2 and PGF2a concentration were measured at each tube. RESULTS: Follicular fluid PGF2a levels were increased in 30 endometriosis patients (P=0.003), and the levels were significantly higher in 11 patients with infertility compared with the control (P=0.001). Peritoneal fluid PGF2a levels were significantly higher in 8 patients with severe dysmenorrhea compared with the others or the control (P=0.028). Follicular or peritoneal fluid PGE2 levels were not different between any group and the control. There was no significant correlation between size of endometrioma and each PG levels. CONCLUSION: Severe dysmenorrhea in endometriosis patients would be related with the high level of peritoneal fluid PGF2a concentration, and infertility in endometriosis would be related with the high level of follicular fluid PGF2a concentration.

Study on Osseointegration of the Immediate Placement Using Korean Implant Systems in Beagle Dog / 대한치주과학회지

This study was attempted to evaluate home-manufactured implants by placing Stage-1(R) Implant (Lifecore. Co., USA) whose surface is treated with RBM that has already been varified clinically, Chaorum(R) Implant(Chaorum Co., Korea) whose surface treatment is same as that of Stage-1 Implant and Atlas(R) Implant(Cewellmedi Co., Korea) whose surface is treated with anodic oxidation immediately after the teeth of experimental animals were extracted to compare histological findings among them. Stage-1 Implant(diameter: 3.5mm, length: 10mm), Chaorum Implant(diameter: 3.3mm, length: 8.5mm) and Cowell medi Implant(diameter: 4.0mm, length: 8.0mm) were placed into the mandible premolars of 2 adult beagle dogs immediately after their teeth were extracted, and then histological findings were analyzed at 6 weeks. After those implants were inserted directly after their teeth were extracted, the results of periotest were recorded, radiography was done, the subjects went through thorough control for 6 weeks, and then comparison among periotest, radiography and histological finding was made. After comparison of those findings, the values of periotest were satisfactory and bone healing was relatively satisfactory on radiography at 6 weeks. For osseointegration with the bone tissue, Stage-1 was 45.3%, Chaorum 55.3%, and Cowellmedi 52.5%, which was a satisfactory result. Although implant surgery immediately after teeth were extracted involves difficulties among recent implant surgeries, it is being frequently used in that it may reduce surgery hours, the frequency of surgery, and bone loss for patients. This experiment was conducted to evaluate the technological levels of home-manufactured implants that have been remarkably developed in recent years and in conclusion, those implants showed nearly similar result.

Height and Shape of Skull Base as Risk Factors for Skull Base Penetration during ESS

BACKGROUND AND OBJECTIVES: CT/MRI has identified several risk factors for life threatening complications of skull base penetration during endoscopic sinus surgery (ESS). We compared these risk factors in groups of patients with and without penetration. MATERIALS AND METHODS: Retrospective review of direct coronal paranasal sinus computed tomography (CT) scans was done. Using preoperative CT scans of 100 patients without penetration, and 7 with penetration, we classified height into 4 groups and contour into 2 groups. The frequencies of shape and height differences of the right and left skull base were calculated in each group. RESULTS: 6 of the 7 patients who had skull base penetration, ESS was performed by a resident or junior staff member having less than 3 years experience with this technique. Shape asymmetry was significantly higher in with penetration (4 out of 7 patients (57%)) and much less in without penetration (18 out of 100 patients, 18%, p=0.032). The frequencies of low skull base and height difference were seen in 15% and 28%, respectively. CONCLUSION: The most important risk factor for inadvertent skull base penetration during ESS is the surgeon's experience and asymmetric shape of the right and left skull base.

The Effect of Body Posture on the Severity of Obstructive Sleep Apnea Syndrome: Comparison of RDI According to BMI and the Anatomic Characteristics of Upper Airway / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is reported that positional therapy, i.e. the avoidance of the supine posture during sleep, is a simple behavioral therapy effective for many OSA patients and that the efficacy of this positional therapy influences RDI and BMI. However, there are no available data on Asians related to positional therapy and little has been studied about the anatomic characteristics of the upper airway. So, we attempted to observe in Korean OSA patients to see how RDI is influenced according to sleep positions and estimate the efficacy of positional therapy according to the degree of tonsillar hypertrophy and the degree of obstruction of oropharynx and hypopharynx. SUBJECTS AND METHOD: We evaluated 112 patients whose RDI were over 5 and whose sleep time of supine position/non-supine position went over 30 minutes as a result of overnight polysomnography taken from December 2003 to July 2004 at the Asan Medical Center. RESULTS: RDI was reduced to the average of 68.7% on non-supine position. The prevalence of positional patients in Korean OSA patients was 76.8%. Positional RDI reduction rate of the obese class II (BMI>30), grade IV oropharyngeal obstruction group on Muller maneuver was significantly lower compared to the other groups. CONCLUSION: The positional therapy was more effective in the Korean OSA patients than in the western OSA patients. However, in the obese class II and the grade IV oropharyngeal obstruction, the efficacy of the positional therapy was lower compared to the other groups.

The Clinical Characteristics and Expression of P21 in Recurrent Early Glottic Cancer after Radiation Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Radiotherapy or surgery is the main treatment modality for early glottic cancer. The advantage of radiotherapy is the preservation of good voice quality after treatment but the main problem of increased complications in the salvage surgery remains when local control fails. So, it is important to predict the success of radiotherapy. Authors aimed to investigate clinical characteristics of recurrent early glottic cancer after radiotherapy and to evaluate the expression of p21 protein as a predictable factor for radiosensitivity in early glottic cancer. SUBJECTS AND METHOD: From 1989 through 2003, 118 patients with T1, T2 glottic squamous cell carcinoma treated primarily with full courses of radiotherapy at the Asan Medical Center were identified. Among them, 20 patients had recurrence. We reviewed medical records retrospectively to find out factors affecting recurrence and performed immunohistochemical staining for p21 protein on the paraffin sections of the biopsy specimens of 75 patients (including 17 cases among 20 patients with recurrent disease). Immunoreactivity to the p21 antibody was evaluated using semi-quantitative scoring system: Grade I for no nuclear reaction, Grade II for 1-10%, Grade III for 10-50%, and Grade IV for 50% or more nuclear staining. We classified immunostaining grades I and II as the weakly positive group, grades III and IV as the strongly positive group. The relation between the local control outcome after radiotherapy and the results of immunostaining was analyzed by the chi-square and the Fisher's exact test. RESULTS: Most of the patients was male (97%), the median follow-up time was 36 months and the average time to recur was 15 months. The recurrence rate was 17% overall, 16% for T1 lesions, 25% for T2 lesions. The unfavorable factor identified in this study for local recurrence was tumor differentiation (p=0.023). Three out of 30 cases of the weakly positive group had recurred and 14 out of 45 cases of the strongly positive group had recurred. There was significantly high recurrence rate in the strongly positive group (p=0.048). CONCLUSION: There was a significant correlation between the poorly differentiated early glottic squamous cell carcinoma and tumor recurrence. The relation between the strongly positive p21 expression and the radioresistance suggests that p21 might be a predictable factor in radioresistancy in early glottic cancer.

Combined Modality Therapy with Selective Bladder Preservation for Muscle Invading Bladder Cancer / 대한방사선종양학회지

PURPOSE: To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. METHOD AND MATERIALS: From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by 39.6~45 Gy pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. RESULT: The patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients (81%) successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients (58%) were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were 80% and 14%, respectively (p=0.001). CONCLUSION: In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

Effect of Intraoperative Fentanyl and Ketorolac Administration on Postoperative Emergence and Analgesia / 대한마취과학회지

BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.

Effect of Intraoperative Fentanyl and Ketorolac Administration on Postoperative Emergence and Analgesia / 대한마취과학회지

BACKGROUND: One of the goals of anesthesia is a complete, comfortable, and rapid recovery without sequelae from anesthesia. Perioperative intravenous fentanyl treatment, due to its rapid onset and brief duration of action, is the one of the most commonly used narcotics. However, the dosage of fentanyl used varies a great deal depending on the purpose and plan of postoperative pain management. When a large dose of fentanyl is used, delayed emergence may occur. This study is designed to evaluate the effective dose of fentanyl and ketorolac for postoperative analgesia. METHODS: Sixty ASA physical status 1 or 2 patients were divided into three groups: fentanyl group (fentanyl 2micro gram/kg, n = 20), mixed group (fentanyl 1micro gram/kg and ketorolac 0.5 mg/kg, n = 20) or ketorolac group (ketolorac 1 mg/kg, n = 20). Each group received a drug ten minutes before the expected termination of the surgical procedure. At the operating room, durations for return of spontaneous breathing, spontaneous eye opening, and extubation were evaluated. At the recovery room, VAS (Visual Analogue Scale) and K-MMSE (Korean Minimental Status Exam) were measured. RESULTS: When compared to the ketolorac group, return times of the spontaneous breathing, spontaneous eye opening, and extubation were prolonged in the fentanyl group (P < 0.05). In the mixed group, the duration of these parameters was intermediate. Postoperative pain scores were also significantly lower in the fentanyl group and mixed group than in the ketorolac group (P < 0.05). The K-MMSE scores for emergence from anesthesia were not significantly different between the three experimental groups. CONCLUSIONS: Based on these results, we suggest that intravenous administration of reduced doses of fentanyl and ketorolac could effectively reduce the pain score without delay from emergence.

A Case of Wernicke-Korsakoff Syndrome Associated with Hyperemesis Gravidarum / 대한산부인과학회잡지

Thiamine deficiency is known to lead to certain neurological sequelae including Wernicke-Korsakoff syndrome. Signs attributable to this condition include ataxia, ophthalmoplegia, nystagmus, and mental confusion. The prompt use of thiamine prevents progression of the disease and reverses those lesions that have not yet progressed to the point of fixed structual change. We have experienced a case of Wernicke-Korsakoff syndrome associated with hyperemesis gravidarum, which seemed to be developed by prolonged thiamine-free dextrose therapy, we emphasise the need for thiamine supplementation in hyperemesis gravidarum patient.